학술논문
Allostatic load predicts racial disparities in intracerebral hemorrhage cognitive outcomes.
Document Type
Academic Journal
Author
Harris J; Division of Stroke and Cerebrovascular Disease, Department of Neurology, Cedars-Sinai Medical Center, 127 S. San Vincente Blvd. #A6600, Los Angeles, CA, USA. Jennifer.harris@cshs.org.; Boehme A; Division of Neurology Clinical Outcomes Research and Population Sciences (Neuro CORPS), Department of Neurology, Columbia University Medical Center, New York, NY, USA.; Chan L; Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York, NY, USA.; Moats H; Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York, NY, USA.; Dugue R; Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York, NY, USA.; Izeogu C; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.; Pavol MA; Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York, NY, USA.; Naqvi IA; Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York, NY, USA.; Williams O; Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York, NY, USA.; Marshall RS; Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York, NY, USA.
Source
Publisher: Nature Publishing Group Country of Publication: England NLM ID: 101563288 Publication Model: Electronic Cited Medium: Internet ISSN: 2045-2322 (Electronic) Linking ISSN: 20452322 NLM ISO Abbreviation: Sci Rep Subsets: MEDLINE
Subject
Language
English
Abstract
A large portion of stroke disparities remains unexplained, even after adjusting for demographic, comorbidity, and health care access variables. There is a critical need to close this knowledge gap by investigating novel factors that may contribute to stroke disparities. Allostatic load (AL) is the lifetime adverse physiologic impact of needing to adjust to socially structured stressors such as racism. AL has been shown to increase health vulnerability and worsen outcomes in marginalized populations. We sought to assess the differential impact of AL on cognitive outcomes post intracerebral hemorrhage (ICH) across race-ethnicity. The Intracerebral Hemorrhage Outcomes Project (ICHOP) prospectively collected data from patients presenting to Columbia Medical Center with ICH from 3/2009 to 5/2016. Data included demographics, stroke scores, labs, complications, neuroimaging, medical history, and discharge data. Five markers of AL (HbA1c, WBC, SBP, HR, ALB) were obtained. An AL score was generated by summing the elements in each patient that fell outside normal ranges, with AL score ranging 0-5. A linear regression model, adjusted for stroke severity and ICH volumes, was used to evaluate the relationship between AL and Modified Telephone Interview for Cognitive Status (TICS-m) at discharge, stratified by race-ethnicity. Among 248 white, 195 black, and 261 Hispanic ICH patients, neither mean AL nor mean TICS differed by race/ethnicity (p = 0.51, p = 0.79 respectively). In the overall cohort AL did not predict TICS at discharge (Beta -1.0, SE 1.1, p = 0.353). In Whites (beta 1.18, SE 2.5, p = 0.646) and Hispanics (beta -0.95, SE 1.6, p = 0.552) AL was not associated with TICS at discharge. In Black patients, higher AL was associated with a decrease in TICS at discharge (beta -3.2, SE 1.5, p = 0.049). AL is an important determinant of post ICH outcomes for certain minority populations. AL may explain some of the unexplained health disparities in stroke populations.
(© 2022. The Author(s).)
(© 2022. The Author(s).)